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Topic: MultiPlan? Heard of it? (Read 13201 times)

Has anyone heard of MultiPlan and billed for it? How does it work? We are a chiropractic office that is in-network with MultiPlan, but out-of-network with UnitedHealth. We have a patient with UHC insurance that we are charging/billing as out-of-network. This patient got an EOB stating that we owe her $200 because we should be billing at the UHC contract rate since we have a contract with MultiPlan. We have no contract with UHC, just MultiPlan. Can anyone help? Thanks!!!

I have actually had a similar situation with UHC. If you par with Multiplan and they are stating that your Multiplan contract applies to this patient then you have to honor that. I would call UHC and make sure that is what is happening and ask how you would know that this is a Multiplan member for the future.

Pay_My_Claims

UHC does utilize Multiplan as a "complimentary" PPO Network. They have also joined with PHCS. Although you are OON with UHC being a network provider of multiplan, you have to bill the patient as in Net since Multiplan is one of the networks that UHC utilizes. It is such a key factor when verifying benefits. Client comes in with MegaLife, we are OON, but use PHCS as the PPO network, we are contracted thus the patient is in network with us. Hope this helps.

I have seen this occur recently for our pediactric PT/OT client. I did some research on it and basically there is no way to tell if the claims will be priced/processed through Multiplan just by looking at the card. My client does not par w/ One Net (formerly MAMSI/Alliance) - so, if they have One Net - we've been treating them as OON (billing the 3rd party payer directly and balance billing the patient the difference). Well, when the EOB came in - it was processed via Multiplan and we had to honor it. I called Guardian (the 3rd party payer) and spoke to a supervisor. They told me that this is a new way for them to handle OON claims. They search for a 'complimentary network' that the provider DOES par with and then re-route the claim to price through them. It benefits the patient b/c they pay less out of pocket and it benefits the payer b/c their contractural fee schedule now applies. Basically it's a very sneaky way to get our claims processed in network! So - now my clients are going to drop Multiplan and PHCS! It's crazy!

Pay_My_Claims

The key again is VERIFICATION!!! It is the first and most important step in the billing process and saves valuable time and money. Knowing how a claim will pay and the benefits of the policy saves providers tons of money and grief. Coming from ins. verification I know what to ask and how to get the answers i need to determine patient benefits, ded, coins, and if auth is req.

I work for a mutlidisciplinary clinic including chiro and just went through a similar situation with Multiplan and UHC. Multiplan merged with PHCS so companies like UHC, regardless of your non-par status. We've been taking a huge hit on our claims since March 1st, they went to a percentage of Medicare's fee schedule and as a non par provider you're getting a lower percentage to begin with. This also keeps you from being able to collect more from the patient. On the majority of our claim's we're losing about 50% to reductions that we're obligated to take then another 30% as a non par provider. It's not worth it to us!

If you're contracted through FHA (Family Health of America) you can contact them to have your claims through UHC reprocessed however if you're contracted individually, you cannot do much about it. The catch is terming your Multiplan contract will not only take 90 days (!!!) but will also term your PHCS contract, though you should definately consider it.

Verifying benefits won't change or prevent anything in these cases since UHC only quote their benes, not the multiplan reductions since they are a seperate entity. Carefully review your contracts and weigh the pros and cons of remaining contracted. If your docs decide to get out of their contract, make sure that you term their group, individual and any other affiliated group contracts, especially with the 3 month term clause or you'll keep seeing this loss of revenue for quite some time. Best of luck!

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Pay_My_Claims

Multiplan works like this: Patient has Empire Plan (NY state employee) His prof services are with UHC and tech with BCBS. If he goes to a par provider with UHC his benefits are whatever they generally are 80% ucr with his ded/copay etc. If he goes to a non par provider but par with Multiplan then his benefits can still be 80% based upon DISCOUNTED charges. EX a physical cost 200.00 they allow 150 and pay 80% in net work (UHC) non par but participates with Multiplan you can they will pay 80% but discount the physical to 100.00.

Again the key is verification. They do not pay your claims as if you are with multiplan when you are not. If you are a UHC provider and they do this, you should contact them and appeal the payment. Before multiplan pays you, they will send you an agreement to accept payment in which you can decline if you are non par like we are.

Hope this helps everyone, but if now, please google multiplan and you can get tons of information direct from them

There are two portions to Multiplan, the discount version which goes claim by claim and is based on a signed agreement and the portion of Multiplan which is a 'PPO network'. Either way the payments never come directly from Multiplan, they come from the insurance company, usually United. With the first type you receive a fax asking you to decrease your fees in exchange for prompt payment, legally they are required to pay your claim within 30 days, so these agreements benefit only Multiplan. The second type has basically forced many providers to accept the out of network percentage on the in-network rate, which results in lost revenue.

The insurance company, in most cases UHC will not tell you that your claims will be processed through mutiplan, they will simply quote the patients out of network benefits. For example as a standard out of network provider, you bill $150, they allow $120 and pay 70% i.e. $88.00 and you can bill the patient as you see fit. Through Multiplan, they take the same $150.00 charge and reduce it to $75 then you receive 70% i.e. $52.50 and are forced to write off the other $75.00. PHCS/Multiplan just reduced their fee schedule, so you could be losing more money than you realize.

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Pay_My_Claims

With the first type you receive a fax asking you to decrease your fees in exchange for prompt payment, legally they are required to pay your claim within 30 days, so these agreements benefit only Multiplan.

Yes, we get these all the time and decline to accept the agreement. We are OON with UHC so we can balance bill the patient. If the client has a secondary claim, (especially medicaid) we just allow them to pay us OON and drop the balance to them. If we accept the payment, they will code it as payment in full and yes we lose money that way.